MEDICARE: DOROTHY EDMONDSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	1280	NC
2	225200000X	Physical Therapy Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2251500000X	OTHER	NC	NPI
2	1280	OTHER	NC	PHYSICAL THERAPIST ASST

General Provider Information

NPI Number	:	1578717922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY EDMONDSON

Provider Business Mailing Address
First Line	:	24777 US HIGHWAY 64
Second Line	:
City	:	WILLIAMSTON
State	:	NC
Zip	:	27892-7733
Country	:	US
Telephone Number	:	252-792-5718
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 EASTERN AVE
Second Line	:
City	:	NASHVILLE
State	:	NC
Zip	:	27856-1716
Country	:	US
Telephone Number	:	252-459-5220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	11/12/2008

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Directions to “ DOROTHY EDMONDSON ” Practice Location

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